多系统结节病误诊为淋巴瘤一例并文献分析

Multiple Systemic Sarcoidosis Misdiagnosed as Lymphoma:One Case Report and Literature Review

目的提高对多系统结节病的认识及诊治水平,避免漏诊、误诊。方法结合相关文献复习对1例多系统结节病患者的诊治进行分析。结果患者表现为咳嗽、咳痰,临床症状无特异性。结节病最易侵犯肺及其他胸部脏器,胸部增强CT特点为双侧肺门淋巴结对称性增大,伴或不伴纵隔淋巴结增大,肿大淋巴结边界清楚,强化均匀,未见融合。PET/CT显像中肿大淋巴结多呈结节样、对称分布。支气管镜下可见支气管黏膜炎症和黏膜结节。结节病的确诊依靠病理学检查。典型的结节病病理表现为散在、紧密的非干酪样坏死性肉芽肿。激素治疗有效。结论结节病是一种病因不明的全身多系统疾病,缺乏特异性临床表征,因而容易误诊。影像学检查及相关实验室检查有助于结节病的诊断。确诊依靠病理检查。

Objective To improve the diagnosis and treatment of multiple systemic sarcoidosis （ MSS） and avoid misdiagnosis. Methods To analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. Results The patients’ clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/ or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose （ FDG） uptake in the hilar and/ or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. Conclusions Sarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific, so it’s likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.